Thailand Agrees to Release 2.812 Billion Baht in Delayed Payments to 894 Hospitals

Hospital payment agreement puts cash flow first

Thailand's Ministry of Public Health and the National Health Security Office (NHSO) have agreed to speed up 2,812.21 million baht in delayed medical payments affecting 894 hospitals, while working out how to recover money previously advanced to keep hospitals operating.

The delayed payments cover Central Reimbursement services, care for patients with chronic kidney disease, and health promotion and disease prevention services paid under the PP Fee Schedule. Hospitals had already provided the care and were waiting for payment. NHSO Secretary-General Dr. Jadej Thamthatcharee put the outstanding amount at 2,812,205,064 baht.

The ministry said the delay arose from a misunderstanding of an approach agreed by a joint committee for managing the 2026 budget. That approach was intended to protect hospital revenue and cash flow, with consultation before decisions about recovering advance transfers.

The agreement addresses two connected pressures: releasing payment for completed medical services and settling an earlier advance of about 4.299 billion baht. The agencies plan to use 3,172.56 million baht in inpatient funding awaiting allocation to manage most of that advance, then jointly decide how to recover the balance through 2027 service payments.

Timing remains crucial for hospitals paying daily bills for medicines, supplies, utilities and staff compensation. On 3 November 2026, Dr. Ratcharin Benchawongsathian, chair of Buddhachinaraj Hospital's medical organization in Phitsanulok and a representative of northern regional and general hospitals, said her hospital alone was waiting for 45 million baht for September services.

The ministry called for payments to be expedited. NHSO said it aimed to settle the detailed arrangements by 15 November 2026 and transfer the money afterward. No exact date for hospitals to receive the funds was given.

What caused the delay?

The joint committee of the ministry and NHSO approved an approach to handling the advance payments on 20 October 2026. It called for the money to be recovered gradually within fiscal 2027, with both agencies agreeing on arrangements that would protect hospital cash flow.

The ministry described the subsequent withholding of medical payments as a misunderstanding of that agreement. Its position was that managing the advance should preserve hospital income and involve consultation with providers before recovery arrangements were put into practice.

Dr. Jadej said NHSO paused the transfers while awaiting discussions with the ministry about how to handle the advance. He said NHSO had not deducted the advance from payments based on services delivered in fiscal 2026.

Hospitals therefore faced a gap between earning payment for care and receiving the cash. Cash flow means having money available when bills fall due. A hospital can be owed a substantial amount for completed treatment while still struggling to pay expenses today.

Dr. Jadej also acknowledged that the notice announcing the delay had not clearly explained its reason, causing concern among hospitals. He said NHSO would improve coordination and give providers clearer information about the arrangements.

Which services are awaiting payment?

The outstanding 2.812 billion baht falls into three categories. Central Reimbursement, or CR, covers specified services paid through a central reimbursement arrangement. Another category covers services for patients with chronic kidney disease. The third covers health promotion and disease prevention under the PP Fee Schedule, which pays according to listed services.

These categories matter because hospitals are waiting for payment across several areas of care, rather than for one isolated programme. Dr. Ratcharin said the claims represented treatment that hospitals had already delivered, while their operating costs continued every day.

The ministry's agreement also provides a route for handling a possible shortfall in the 2026 Central Reimbursement budget. If that budget is insufficient, the agencies will follow the National Health Security Board's approach of using the 2027 budget to cover eligible service costs.

That arrangement puts some responsibility for earlier care into the following budget year. Hospitals would gain a funding route for eligible unpaid services, while the agencies would have to manage those obligations alongside payments for newer care.

How will the 4.299 billion baht advance be settled?

NHSO had transferred 4,299,215,259 baht in advance inpatient allocations to hospitals under the Office of the Permanent Secretary during fiscal 2026. Dr. Jadej said the purpose was to support their liquidity, meaning their ability to meet immediate expenses.

The ministry said 3,172.56 million baht in inpatient fund allocations awaiting distribution would be used to manage that advance. Compared with the rounded advance total of 4,299 million baht, this covers about 74%, leaving roughly 1.13 billion baht. The ministry described the possible remaining balance as about 1 billion baht.

The agencies will jointly determine how any outstanding balance can be recovered from hospitals' 2027 service payments. They have committed to consulting providers beforehand and giving priority to hospital liquidity.

For a hospital, recovery through future payments means some money it would otherwise receive for later services may be retained to settle the earlier advance. The amount taken at a time, and when it is taken, therefore affect how much cash is available for current bills.

Dr. Somruek Ch Jungsamarn, permanent secretary for public health, described the shared commitment to gradual recovery. Speaking in Thai, he said:

The Ministry of Public Health and NHSO have agreed that the money will be gradually recovered in fiscal 2027. Both agencies will jointly determine an appropriate approach that does not affect hospital liquidity, which is something we both prioritize.

A large hospital describes the pressure

Buddhachinaraj Hospital's 45 million baht in delayed September payments gives a concrete example of the pressure behind the national figures. Dr. Ratcharin said even a large hospital had to keep meeting daily costs while waiting for money owed for treatment.

Some hospitals had postponed performance related payments known as P4P, compensation linked to workload, and other staff payments tied to hospital operating funds, she said. Her account shows how a delay in institutional funding can reach the people delivering care through delayed compensation.

Larger hospitals had previously helped facilities in their health regions facing level 7 financial distress, described as a red crisis category. Dr. Ratcharin said Buddhachinaraj had helped support hospitals in that position.

Widespread payment delays reduced the room for that support. When larger hospitals also need to conserve cash, they have less capacity to help nearby facilities already under financial strain.

Dr. Ratcharin warned that delays extending beyond the planned 15 November discussions would place further pressure on hospitals. They would still have to carry their expenses and continue serving patients while waiting for payment.

Why advance funding leaves hospitals concerned

Dr. Ratcharin welcomed the push to release the delayed money, use inpatient allocations to manage the advance, and address any Central Reimbursement shortfall. Her concern extended to how hospitals would be funded after the immediate payment problem was resolved.

The earlier transfer of more than 4 billion baht had helped hospitals facing severe cash shortages, she said. Hospitals nevertheless worried about how that money would later be offset against payments, particularly if recovery reduced their income near the end of a budget period.

An advance changes when money arrives. Funding based on the cost and volume of treatment addresses how much hospitals receive for the work they perform. Dr. Ratcharin argued that the second issue needed attention alongside the immediate release of cash.

Dr. Ratcharin, speaking in Thai, described her preferred approach:

We do not actually want advance transfers as assistance, because this is not a good way to solve public hospitals' financial problems. The best approach would be to allocate budgets according to actual costs and actual service volumes.

Her proposal would tie funding more closely to the care hospitals deliver and the expense of providing it. The agreement announced by the ministry concentrates on releasing outstanding payments and managing recovery of the previous advance.

What has already been paid for fiscal 2027?

NHSO said it had already transferred 25% of fiscal 2027 outpatient and health promotion and disease prevention budgets in advance. Those transfers followed a National Health Security Board resolution dated 7 October 2026.

Outpatient services are care delivered without admitting a patient to hospital. Health promotion and disease prevention budgets support services intended to keep people healthy and prevent illness. Dr. Jadej said the advance transfers were intended to support hospital liquidity and continuity of care.

The 2027 transfers sit alongside the unresolved payments for 2026 services and the earlier inpatient advance. Hospitals are consequently managing money associated with different service categories and budget years at the same time.

Clear payment schedules matter in that situation. Providers need to know when outstanding claims will be paid and how much future income will be retained to recover advances so they can plan spending on care and staffing.

The dates behind the agreement

The decisions span the close of fiscal 2026 and arrangements for fiscal 2027. The main dates show how the funding measures and payment dispute developed:

• September 2026: Buddhachinaraj Hospital provided services for which Dr. Ratcharin said 45 million baht remained unpaid.
• 7 October 2026: The National Health Security Board passed the resolution behind advance transfers of 25% of fiscal 2027 outpatient and health promotion and disease prevention budgets.
• 20 October 2026: The joint ministry and NHSO committee approved an approach to gradually recovering the earlier inpatient advance within fiscal 2027.
• 3 November 2026: NHSO explained the payment pause, while Dr. Ratcharin described the financial pressure on hospitals.
• 15 November 2026: NHSO's stated target for reaching agreement on detailed arrangements, with transfers to follow.

The ministry's stated goal is to maintain cash flow, keep quality care running and manage public money effectively. For hospitals, the practical result will depend on receiving the delayed payments and having a recovery schedule they can plan around.

Key Points

• The ministry and NHSO agreed to expedite 2,812.21 million baht in delayed payments affecting 894 hospitals.
• The payments cover Central Reimbursement, chronic kidney disease services, and listed health promotion and disease prevention services.
• NHSO said it had not deducted the earlier advance from fiscal 2026 service payments.
• The agencies plan to use 3,172.56 million baht in inpatient allocations to manage most of the approximately 4.299 billion baht advance.
• Any remaining recovery through 2027 service payments is to be arranged jointly, with consultation and attention to hospital liquidity.
• NHSO set 15 November 2026 as its target for settling the details before transferring the delayed payments.
• Buddhachinaraj Hospital reported 45 million baht in delayed September payments, while some hospitals postponed staff compensation.